Pineapple bromelain (generic name)
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Interactions with Drugs
In theory, bromelain may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). In addition, bromelain theoretically may add to the anti-inflammatory effects of NSAIDs.
Human studies suggest that bromelain may increase the absorption of some antibiotics, notably amoxicillin and tetracycline, and increase the levels of these drugs in the body. Bromelain may increase the actions of the chemotherapy (anti-cancer) drugs 5-fluorouracil and vincristine, although reliable scientific research in this area is lacking. In theory, use of bromelain with blood pressure medications in the "ACE inhibitor" class, such as captopril (Capoten®) or lisinopril (Zestril®), may cause larger drops in blood pressure than expected.
Some experts suggest that bromelain may cause drowsiness or sedation and may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
Bromelain may also interact with heartbeat regulating medications, magnesium, and nicotine.
Interactions with Herbs and Dietary Supplements
In theory, bromelain may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Bromelain and the enzyme trypsin are suggested to have stronger anti-inflammatory effects when combined, based on preliminary animal research. It has been suggested that zinc might block the effects of bromelain in the body while magnesium may increase the effects, although scientific research in these areas is lacking.
Bromelain may also interact with herbs and supplements that effect the heart, antibacterials, soy, sedatives, and tobacco.
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD, MSc, MPhil (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cynthia Dacey, PharmD (Northeastern University); Mary McGarry, PharmD (University of Rhode Island); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).